Baseline Impedance Measured During High-resolution Esophageal Impedance Manometry in Patients With Rumination Syndrome is as Abnormal as in Patients With GERD.


Journal

Journal of clinical gastroenterology
ISSN: 1539-2031
Titre abrégé: J Clin Gastroenterol
Pays: United States
ID NLM: 7910017

Informations de publication

Date de publication:
01 2020
Historique:
pubmed: 24 12 2018
medline: 29 4 2021
entrez: 22 12 2018
Statut: ppublish

Résumé

Baseline impedance measured during high-resolution impedance manometry (HRIM) can distinguish patients with gastroesophageal reflux disease (GERD) from controls, presumably due to differences in esophageal acid exposure. The characteristics of regurgitation and reflux in rumination syndrome and GERD are very different, and thus we investigated whether baseline esophageal impedance would differ in these 2 patient groups compared with controls. We compared 20 patients with rumination syndrome with 20 patients who had GERD and 40 controls. Baseline impedance was measured over 15 seconds during the landmark period of HRIM in all 18 impedance sensors on a HRIM catheter. The mean distal baseline impedance measured in ohms during HRIM was 1336 Ω [95% confidence interval (CI)=799, 1873) in patients with GERD, 1536 Ω in rumination syndrome (95% CI=1012, 2061), and 3379 Ω in controls (95% CI=2999, 3759) (P<0.0001). Proximal impedance was significantly lower in the GERD and rumination groups compared with controls; rumination syndrome (2026; 95% CI=1493, 2559 Ω), GERD (2572; 95% CI=2027, 3118 Ω), and controls (3412; 95% CI=3026, 3798 Ω) (P<0.001). Baseline impedance measured during HRIM in patients with rumination syndrome is significantly lower than controls and appears similar to patients with GERD both in the proximal and distal esophagus. These findings suggest that the postprandial regurgitation in rumination syndrome alters both the distal and proximal esophageal mucosal barrier.

Sections du résumé

GOALS AND BACKGROUND
Baseline impedance measured during high-resolution impedance manometry (HRIM) can distinguish patients with gastroesophageal reflux disease (GERD) from controls, presumably due to differences in esophageal acid exposure. The characteristics of regurgitation and reflux in rumination syndrome and GERD are very different, and thus we investigated whether baseline esophageal impedance would differ in these 2 patient groups compared with controls.
STUDY
We compared 20 patients with rumination syndrome with 20 patients who had GERD and 40 controls. Baseline impedance was measured over 15 seconds during the landmark period of HRIM in all 18 impedance sensors on a HRIM catheter.
RESULTS
The mean distal baseline impedance measured in ohms during HRIM was 1336 Ω [95% confidence interval (CI)=799, 1873) in patients with GERD, 1536 Ω in rumination syndrome (95% CI=1012, 2061), and 3379 Ω in controls (95% CI=2999, 3759) (P<0.0001). Proximal impedance was significantly lower in the GERD and rumination groups compared with controls; rumination syndrome (2026; 95% CI=1493, 2559 Ω), GERD (2572; 95% CI=2027, 3118 Ω), and controls (3412; 95% CI=3026, 3798 Ω) (P<0.001).
CONCLUSIONS
Baseline impedance measured during HRIM in patients with rumination syndrome is significantly lower than controls and appears similar to patients with GERD both in the proximal and distal esophagus. These findings suggest that the postprandial regurgitation in rumination syndrome alters both the distal and proximal esophageal mucosal barrier.

Identifiants

pubmed: 30575633
doi: 10.1097/MCG.0000000000001159
pii: 00004836-202001000-00006
doi:

Types de publication

Comparative Study Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

28-34

Références

Stanghellini V, Chan FK, Hasler WL, et al. Gastroduodenal disorders. Gastroenterology. 2016;150:1380–1392.
Vijayvargiya P, Iturrino J, Camilleri M, et al. Novel association of rectal evacuation disorder and rumination syndrome: diagnosis, co-morbidities and treatment. United European Gastroenterol J. 2014;2:38–46.
Tucker E, Knowles K, Wright J, et al. Rumination variations: aetiology and classification of abnormal behavioural responses to digestive symptoms based on high-resolution manometry studies. Aliment Pharmacol Ther. 2013;37:263–274.
Kessing B, Bredenoord A, Smout A. Objective manometric criteria for the rumination syndrome. Am J Gastroenterol. 2014;109:52–59.
Barba E, Accarino A, Soldevilla A, et al. Randomized, placebo-controlled trial of biofeedback for the treatment of rumination. Am J Gastroenterol. 2016;111:1007–1013.
Malcolm A, Thumshirn MB, Camilleri M, et al. Rumination syndrome. Mayo Clinic Proc. 1997;72:646–652.
Thumshirn M, Camilleri M, Hanson RB, et al. Gastric mechanosensory and lower esophageal sphincter function in rumination syndrome. Am J Physiol. 1998;275(pt 1):G314–G321.
Kandulski A, Weigt J, Caro C, et al. Esophageal intraluminal baseline impedance differentiates gastroesophageal reflux disease from functional heartburn. Clin Gastroenterol Hepatol. 2015;13:1075–1081.
Kessing BF, Bredenoord AJ, Weijenborg PW, et al. Esophageal acid exposure decreases intraluminal baseline impedance levels. Am J Gastroenterol. 2011;106:2093–2097.
Frazzoni M, Savarino E, de Bortoli N, et al. Analyses of the post-reflux swallow-induced peristaltic wave index and nocturnal baseline impedance parameters increase the diagnostic yield of impedance-pH monitoring of patients with reflux disease. Clin Gastroenterol Hepatol. 2016;14:40–46.
de Bortoli N, Martinucci I, Savarino E, et al. Association between baseline impedance values and response proton pump inhibitors in patients with heartburn. Clin Gastroenterol Hepatol. 2015;13:1082–1088.
Martinucci I, de Bortoli N, Savarino E, et al. Esophageal baseline impedance levels in patients with pathophysiological characteristics of functional heartburn. Neurogastroenterol Motil. 2014;26:546–555.
Ravi K, Geno DM, Vela MF, et al. Baseline impedance measured during high-resolution esophageal impedance manometry reliably discriminates GERD patients. Neurogastroenterol Motil. 2016. [Epub October 24, 2016].
Saritas Yuksel E, Higginbotham T, Slaughter JC, et al. Use of direct, endoscopic-guided measurements of mucosal impedance in diagnosis of gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2012;10:1110–1116.
Ates F, Yuksel ES, Higginbotham T, et al. Mucosal impedance discriminates GERD from non-GERD conditions. Gastroenterology. 2015;148:334–343.
Weijenborg PW, Rohof WO, Akkermans LM, et al. Electrical tissue impedance spectroscopy: a novel device to measure esophageal mucosal integrity changes during endoscopy. Neurogastroenterol Motil. 2013;25:574–578.
Weijenborg PW, Smout AJJ, Verseijden C, et al. Hypersensitivity to acid is associated with impaired esophageal mucosal integrity in patients with gastroesophageal reflux disease with and without esophagitis. Am J Physiol Gastrointest Liver Physiol. 2014;307:G323–G329.
Choksi Y, Lal P, Slaughter JC, et al. Esophageal mucosal impedance patterns discriminate patients with eosinophilic esophagitis from patients with GERD. Clin Gastroenterol Hepatol. 2018;16:664–6710.
Barrett C, Choksi Y, Vaezi MF. Mucosal impedance: a new approach to diagnosing gastroesophageal reflux disease and eosinophilic esophagitis. Curr Gastroenterol Rep. 2018;20:33.
Orlando LA, Orlando RC. Dilated intercellular spaces as a marker of GERD. Curr Gastroenterol Rep. 2009;11:190–194.
Tobey NA, Carson JL, Alkiek RA, et al. Dilated intercellular spaces: a morphological feature of acid reflux—damaged human esophageal epithelium. Gastroenterology. 1996;111:1200–1205.
Caviglia R, Ribolsi M, Gentile M, et al. Dilated intercellular spaces and acid reflux at the distal and proximal oesophagus in patients with non-erosive gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2007;25:629–636.
Tobey NA, Argote CM, Vanegas XC, et al. Electrical parameters and ion species for active transport in human esophageal stratified squamous epithelium and Barrett’s specialized columnar epithelium. Am J Physiol Gastrointest Liver Physiol. 2007;293:G264–G270.
Woodland P, Lee C, Duraisamy Y, et al. Assessment and protection of esophageal mucosal integrity in patients with heartburn without esophagitis. Am J Gastroenterol. 2013;108:535–543.
Tack J, Talley N, Camilleri M, et al. Functional gastroduodenal disorders. Gastroenterology. 2006;130:1466–1479.
Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–174.
Alexander JA, Ravi K, Geno DM, et al. Comparison of mucosal impedance measurements throughout the esophagus and mucosal eosinophil counts in endoscopic biopsies in eosinophilic esophagitis. Gastrointest Endosc. 2018. [Epub ahead of print].
Patel A, Sayuk GS, Gyawali CP. Acid-based parameters on pH-impedance testing predict symptom improvement with medical management better than impedance parameters. Am J Gastroenterol. 2014;109:836–844.
Pauwels A, Broers C, Van Houtte B, et al. A randomized double-blind, placebo-controlled, cross-over study using baclofen in the treatment of rumination syndrome. Am J Gastroenterol. 2018;113:97–104.
Schupack D, Katzka DA, Geno DM, et al. The clinical significance of esophagogastric junction outflow obstruction and hypercontractile esophagus in high resolution esophageal manometry. Neurogastroenterol Motil. 2017;29:1–9.

Auteurs

Magnus Halland (M)

Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester MN.

Karthik Ravi (K)

Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester MN.

Holly A Nelson (HA)

Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester MN.

David A Katzka (DA)

Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester MN.

Nicholas J Talley (NJ)

Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester MN.

Michael D Crowell (MD)

Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale AZ.

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